Fill in this information to identify your case:

United States Bankruptcy Court for the:

NORTHERN DISTRICT OF ILLINOIS, EASTERN DIVISION

Case number (if known) Chapter you are filing under:  Chapter 7

 Chapter 11

 Chapter 12

 Chapter 13  Check if this an amended

filing

Official Form 101

Voluntary Petition for Individuals Filing for Bankruptcy 12/15

The bankruptcy forms use you and Debtor 1 to refer to a debtor filing alone. A married couple may file a bankruptcy case together—called a joint case—and in joint cases, these forms use you to ask for information from both debtors. For example, if a form asks, “Do you own a car,”the answer would be yes if either debtor owns a car. When information is needed about the spouses separately, the form uses Debtor 1 and Debtor 2 to distinguish

between them. In joint cases, one of the spouses must report information as Debtor 1 and the other as Debtor 2. The same person must be Debtor 1 in all of the forms.

Be as complete and accurate as possible. If two married people are filing together, both are equally responsible for supplying correct information. If more

space is needed, attach a separate sheet to this form. On the top of any additional pages, write your name and case number (if known). Answer every

question.

Part 1: Identify Yourself

About Debtor 1: About Debtor 2 (Spouse Only in a Joint Case):

1. Your full name Write the name that is on

your government-issued

picture identification (for example, your driver's

license or passport).

Bring your picture

identification to your meeting with the trustee.

Jose

First name First name

Middle name Middle name

Rios

Last name and Suffix (Sr., Jr., II, III) Last name and Suffix (Sr., Jr., II, III)

2. All other names you have used in the last 8 years

Include your married or

maiden names.

Jose Rios Meza

3. Only the last 4 digits of

your Social Security number or federal

Individual Taxpayer

Identification number

(ITIN)

xxx-xx-3589

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Debtor 1 Rios, Jose Case number (if known)

About Debtor 1: About Debtor 2 (Spouse Only in a Joint Case):

4. Any business names and

Employer Identification Numbers (EIN) you have used in the last 8 years  I have not used any business name or EINs.  I have not used any business name or EINs.

Include trade names and

doing business as names Business name(s) Business name(s)

EINs EINs

5. Where you live If Debtor 2 lives at a different address:

2034 W 18th St

Chicago, IL 60608-1816

Number, Street, City, State & ZIP Code Number, Street, City, State & ZIP Code

Cook

County County

If your mailing address is different from the one

above, fill it in here. Note that the court will send any

notices to you at this mailing address.

If Debtor 2's mailing address is different from yours, fill it in

here. Note that the court will send any notices to this mailing

address.

Number, P.O. Box, Street, City, State & ZIP Code Number, P.O. Box, Street, City, State & ZIP Code

6. Why you are choosing

this district to file for bankruptcy

Check one:

 Over the last 180 days before filing this petition, I

have lived in this district longer than in any other district.

 I have another reason. Explain. (See 28 U.S.C. § 1408.)

Check one:

 Over the last 180 days before filing this petition, I have

lived in this district longer than in any other district.

 I have another reason. Explain. (See 28 U.S.C. § 1408.)

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Debtor 1 Rios, Jose Case number (if known)

Part 2: Tell the Court About Your Bankruptcy Case

7. The chapter of the Bankruptcy Code you are

choosing to file under

Check one. (For a brief description of each, see Notice Required by 11 U.S.C. § 342(b) for Individuals Filing for Bankruptcy (Form

2010)). Also, go to the top of page 1 and check the appropriate box.  Chapter 7

 Chapter 11

 Chapter 12

 Chapter 13

8. How you will pay the fee  I will pay the entire fee when I file my petition. Please check with the clerk’s office in your local court for more details about how you may pay. Typically, if you are paying the fee yourself, you may pay with cash, cashier’s check, or money order.

If your attorney is submitting your payment on your behalf, your attorney may pay with a credit card or check with a

pre-printed address.  I need to pay the fee in installments. If you choose this option, sign and attach the Application for Individuals to Pay The Filing Fee in Installments (Official Form 103A).

 I request that my fee be waived (You may request this option only if you are filing for Chapter 7. By law, a judge may, but is not required to, waive your fee, and may do so only if your income is less than 150% of the official poverty line that applies to

your family size and you are unable to pay the fee in installments). If you choose this option, you must fill out the Application

to Have the Chapter 7 Filing Fee Waived (Official Form 103B) and file it with your petition.

9. Have you filed for bankruptcy within the last

8 years?

 No.

Yes. District When Case number

District When Case number

District When Case number

10. Are any bankruptcy cases pending or being filed by

a spouse who is not filing

this case with you, or by

a business partner, or by

an affiliate?

 No

Yes.

Debtor Relationship to you

District When Case number, if known Debtor Relationship to you

District When Case number, if known

11. Do you rent your

residence?

 No. Go to line 12.

Yes. Has your landlord obtained an eviction judgment against you and do you want to stay in your residence?

 No. Go to line 12.

 Yes. Fill outInitial Statement About an Eviction Judgment Against You (Form 101A) and file it with this

bankruptcy petition.

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Part 3: Report About Any Businesses You Own as a Sole Proprietor

12. Are you a sole proprietor of any full- or part-time business?

 No. Go to Part 4.

Yes. Name and location of business

A sole proprietorship is a

business you operate as an

individual, and is not a

separate legal entity such as a corporation, partnership, or LLC.

Name of business, if any

If you have more than one

sole proprietorship, use a

separate sheet and attach it

to this petition.

Number, Street, City, State & ZIP Code

Check the appropriate box to describe your business:  Health Care Business (as defined in 11 U.S.C. § 101(27A))

 Single Asset Real Estate (as defined in 11 U.S.C. § 101(51B))

 Stockbroker (as defined in 11 U.S.C. § 101(53A))

 Commodity Broker (as defined in 11 U.S.C. § 101(6))

 None of the above

13. Are you filing under Chapter 11 of the Bankruptcy Code and are

you a small business debtor?

If you are filing under Chapter 11, the court must know whether you are a small business debtor so that it can set appropriate

deadlines. If you indicate that you are a small business debtor, you must attach your most recent balance sheet, statement of operations, cash-flow statement, and federal income tax return or if any of these documents do not exist, follow the procedure in 11

U.S.C. 1116(1)(B).

For a definition of small

business debtor, see 11

U.S.C. § 101(51D).  No. I am not filing under Chapter 11.

 No. I am filing under Chapter 11, but I am NOT a small business debtor according to the definition in the Bankruptcy

Code.

Yes.

I am filing under Chapter 11 and I am a small business debtor according to the definition in the Bankruptcy Code.

Part 4: Report if You Own or Have Any Hazardous Property or Any Property That Needs Immediate Attention

14. Do you own or have any

property that poses or is

alleged to pose a threat of

imminent and identifiable hazard to public health or safety? Or do you own

any property that needs

immediate attention?

 No.

Yes. What is the hazard?

If immediate attention is needed, why is it needed?

For example, do you own

perishable goods, or

livestock that must be fed, or a building that needs urgent repairs?

Where is the property?

Number, Street, City, State & Zip Code

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Part 5: Explain Your Efforts to Receive a Briefing About Credit Counseling

About Debtor 1: About Debtor 2 (Spouse Only in a Joint Case): 15. Tell the court whether you have received a briefing about credit counseling.

The law requires that you

receive a briefing about credit counseling before you

file for bankruptcy. You must truthfully check one of

the following choices. If you

cannot do so, you are not

eligible to file.

If you file anyway, the court can dismiss your case, you will lose whatever filing fee

you paid, and your creditors

can begin collection

activities again.

You must check one: You must check one:

 I received a briefing from an approved credit counseling agency within the 180 days before I

filed this bankruptcy petition, and I received a

certificate of completion. Attach a copy of the certificate and the payment plan,

if any, that you developed with the agency.

 I received a briefing from an approved credit counseling agency within the 180 days before I filed

this bankruptcy petition, and I received a certificate of completion. Attach a copy of the certificate and the payment plan, if any,

that you developed with the agency.  I received a briefing from an approved credit counseling agency within the 180 days before I

filed this bankruptcy petition, but I do not have a

certificate of completion. Within 14 days after you file this bankruptcy petition, you MUST file a copy of the certificate and payment

plan, if any.

 I received a briefing from an approved credit counseling agency within the 180 days before I filed

this bankruptcy petition, but I do not have a certificate of completion. Within 14 days after you file this bankruptcy petition, you MUST file a copy of the certificate and payment plan, if any.  I certify that I asked for credit counseling

services from an approved agency, but was unable to obtain those services during the 7

days after I made my request, and exigent circumstances merit a 30-day temporary waiver of the requirement.

To ask for a 30-day temporary waiver of the

requirement, attach a separate sheet explaining what efforts you made to obtain the briefing, why you were

unable to obtain it before you filed for bankruptcy, and what exigent circumstances required you to file this

case. Your case may be dismissed if the court is dissatisfied with your reasons for not receiving a

briefing before you filed for bankruptcy.

If the court is satisfied with your reasons, you must still receive a briefing within 30 days after you file. You must file a certificate from the approved agency, along with a copy of the payment plan you developed,

if any. If you do not do so, your case may be

dismissed.

Any extension of the 30-day deadline is granted only

for cause and is limited to a maximum of 15 days.

 I certify that I asked for credit counseling services

from an approved agency, but was unable to obtain

those services during the 7 days after I made my

request, and exigent circumstances merit a 30-day

temporary waiver of the requirement.

To ask for a 30-day temporary waiver of the requirement, attach a separate sheet explaining what efforts you made to

obtain the briefing, why you were unable to obtain it before

you filed for bankruptcy, and what exigent circumstances

required you to file this case. Your case may be dismissed if the court is dissatisfied with

your reasons for not receiving a briefing before you filed for bankruptcy.

If the court is satisfied with your reasons, you must still

receive a briefing within 30 days after you file. You must file

a certificate from the approved agency, along with a copy of

the payment plan you developed, if any. If you do not do so, your case may be dismissed. Any extension of the 30-day deadline is granted only for cause and is limited to a maximum of 15 days.

 I am not required to receive a briefing about credit counseling because of:  I am not required to receive a briefing about credit counseling because of:  Incapacity.

I have a mental illness or a mental deficiency

that makes me incapable of realizing or making

rational decisions about finances.

 Incapacity.

I have a mental illness or a mental deficiency that

makes me incapable of realizing or making rational

decisions about finances.  Disability.

My physical disability causes me to be unable

to participate in a briefing in person, by phone, or through the internet, even after I reasonably

tried to do so.

 Disability.

My physical disability causes me to be unable to

participate in a briefing in person, by phone, or through

the internet, even after I reasonably tried to do so.  Active duty.

I am currently on active military duty in a

military combat zone.

 Active duty.

I am currently on active military duty in a military

combat zone.

If you believe you are not required to receive a briefing

about credit counseling, you must file a motion for waiver credit counseling with the court.

If you believe you are not required to receive a briefing about credit counseling, you must file a motion for waiver of credit counseling with the court.

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Debtor 1 Rios, Jose Case number (if known)

Part 6: Answer These Questions for Reporting Purposes

16. What kind of debts do

you have?

16a. Are your debts primarily consumer debts? Consumer debts are defined in 11 U.S.C. § 101(8) as “incurred by an

individual primarily for a personal, family, or household purpose.”  No. Go to line 16b.

 Yes. Go to line 17.

16b. Are your debts primarily business debts? Business debts are debts that you incurred to obtain money

for a business or investment or through the operation of the business or investment. No. Go to line 16c.

 Yes. Go to line 17.

16c. State the type of debts you owe that are not consumer debts or business debts

17. Are you filing under Chapter 7?

 No. I am not filing under Chapter 7. Go to line 18.

Do you estimate that after any exempt property is

excluded and

administrative expenses

are paid that funds will be

available for distribution

to unsecured creditors?

Yes.

I am filing under Chapter 7. Do you estimate that after any exempt property is excluded and administrative expenses are

paid that funds will be available to distribute to unsecured creditors?

 No

Yes

18. How many Creditors do

you estimate that you

owe?

 1-49

 50-99

 100-199

 200-999

 1,000-5,000

 5001-10,000

 10,001-25,000

 25,001-50,000

 50,001-100,000

 More than100,000

19. How much do you

estimate your assets to

be worth?

 $0 - $50,000

 $50,001 - $100,000

 $100,001 - $500,000

 $500,001 - $1 million

 $1,000,001 - $10 million

 $10,000,001 - $50 million

 $50,000,001 - $100 million

 $100,000,001 - $500 million

 $500,000,001 - $1 billion

 $1,000,000,001 - $10 billion

 $10,000,000,001 - $50 billion

More than $50 billion

20. How much do you

estimate your liabilities to

be?

 $0 - $50,000

 $50,001 - $100,000

 $100,001 - $500,000

 $500,001 - $1 million

 $1,000,001 - $10 million

 $10,000,001 - $50 million

 $50,000,001 - $100 million

 $100,000,001 - $500 million

 $500,000,001 - $1 billion

 $1,000,000,001 - $10 billion

 $10,000,000,001 - $50 billion

 More than $50 billion

Part 7: Sign Below

For you I have examined this petition, and I declare under penalty of perjury that the information provided is true and correct.

If I have chosen to file under Chapter 7, I am aware that I may proceed, if eligible, under Chapter 7, 11,12, or 13 of title 11, United

States Code. I understand the relief available under each chapter, and I choose to proceed under Chapter 7.

If no attorney represents me and I did not pay or agree to pay someone who is not an attorney to help me fill out this document, I

have obtained and read the notice required by 11 U.S.C. § 342(b).

I request relief in accordance with the chapter of title 11, United States Code, specified in this petition.

I understand making a false statement, concealing property, or obtaining money or property by fraud in connection with a bankruptcy

case can result in fines up to $250,000, or imprisonment for up to 20 years, or both. 18 U.S.C. §§ 152, 1341, 1519, and 3571.

Jose Rios Signature of Debtor 2

Signature of Debtor 1

Executed on August 17, 2016 Executed on MM / DD / YYYY MM / DD / YYYY

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Debtor 1 Rios, Jose Case number (if known)

For your attorney, if you are

represented by one

If you are not represented by

an attorney, you do not need

to file this page.

I, the attorney for the debtor(s) named in this petition, declare that I have informed the debtor(s) about eligibility to proceed under Chapter 7, 11, 12, or 13 of title 11, United States Code, and have explained the relief available under each chapter for which the

person is eligible. I also certify that I have delivered to the debtor(s) the notice required by 11 U.S.C. § 342(b) and, in a case in which § 707(b)(4)(D) applies, certify that I have no knowledge after an inquiry that the information in the schedules filed with the

petition is incorrect.

Date August 17, 2016

Signature of Attorney for Debtor MM / DD / YYYY

Juan M. Soliz

Printed name Juan M Soliz & Associates

Firm name

3203 S Pulaski Rd

Chicago, IL 60623-4920

Number, Street, City, State & ZIP Code

Contact phone Email address lawsoliz@sbcglobal.net

99999

Bar number & State

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